Provider Demographics
NPI:1205101607
Name:COLE, ABBY (PA-C)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 BETTEN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-3084
Mailing Address - Country:US
Mailing Address - Phone:402-239-7544
Mailing Address - Fax:
Practice Address - Street 1:2910 BETTEN DR
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3084
Practice Address - Country:US
Practice Address - Phone:402-826-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
093416011Medicare PIN